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Prof Ariyanto Harsono MD PhD SpA(K)
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Prof Ariyanto Harsono MD, PhD, SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
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First developed at St Mary Hospital
London at the end of 19th century.
Basic Principle: Noon and Freeman
Cornerstone in the management of asthma and allergic rhinitis
Prof Ariyanto Harsono MD PhD SpA(K)
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Tree polen
Prof Ariyanto Harsono MD PhD SpA(K)
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Prof Ariyanto Harsono MD PhD SpA(K)
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Prof Ariyanto Harsono MD PhD SpA(K)
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Bee sting
Prof Ariyanto Harsono MD PhD SpA(K)
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Dermatophagoides pterisynus
Prof Ariyanto Harsono MD PhD SpA(K)
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Dermatophagoides farinai
Prof Ariyanto Harsono MD PhD SpA(K)
9The main allergen is the feces of mite
Prof Ariyanto Harsono MD PhD SpA(K)
10Transepithelial
deliveryof allergen
Indirect proteolysisof TJ protein
Direct proteolysisof TJ protein
Der p1/Der f1 Der p1/Der f1 Der p1/Der f1
Prof Ariyanto Harsono MD PhD SpA(K)
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Atopy
Prof Ariyanto Harsono MD PhD SpA(K)
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allergen
2004: 3:234-237
Allergy AllergyGrow out
AllergenExposure
Allergen IT
Prof Ariyanto Harsono MD PhD SpA(K)
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TLR 1,2,6,7,8,11
Respon imun melawan infeksi faktor-faktor yang mempengaruhi respon
Subset Dendritic Cell
Subset DC1
IL-12
Nat Rev Immunol, 2003,3:984-93Prof Ariyanto Harsono MD PhD
SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
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Respon imun melawan infeksi faktor-faktor yang mempengaruhi respon
Subset Dendritic Cell
Subset DC2
TLR 1,4,7,9,10
IL-13
Nat Rev Immunol, 2003,3:984-93Prof Ariyanto Harsono MD PhD
SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
152004: 3:234-237
Allergen exposureAllergen IT
Prof Ariyanto Harsono MD PhD SpA(K)
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Pre Immunotherapy Post Immunotherapy
J Allergy Clin Immunol 2004 • Volume 113 • Number 6 :1234-1237
Prof Ariyanto Harsono MD PhD SpA(K)
17Prof Ariyanto Harsono MD PhD
SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
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Allergen exposure
IL-4, IL-5
IL-13
Th-2 CellIL-13
B Cell
Prof Ariyanto Harsono MD PhD SpA(K)
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IgG
Allergen IT
Th-1 CellIL-12 IFN-IL-2
B Cell
Prof Ariyanto Harsono MD PhD SpA(K)
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Pre Immunotherapy Post Immunotherapy
J Allergy Clin Immunol 2004 • Volume 113 • Number 6 :1234-1237
Prof Ariyanto Harsono MD PhD SpA(K)
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: Pre Immunotherapy
Post Immunotherapy
J Allergy Clin Immunol 2004 • Volume 113 • Number 6 :1234-1237
IFN-
Prof Ariyanto Harsono MD PhD SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
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Pre Immunotherapy
Post Immunotherapy
J Allergy Clin Immunol 2004 • Volume 113 • Number 6 :1234-1237
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Other study…
Durham 1998, reported reduce of IL-4 and IL-5; increase of IFN- and IL-2 as well as reduce of IgE and increase IgG resulted in the diminish late phase reaction
(JACI 1998;102:157-64)
IL-2
Prof Ariyanto Harsono MD PhD SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
242004: 3:234-237
Prof Ariyanto Harsono MD PhD SpA(K)
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2004: 3:234-237Prof Ariyanto Harsono MD PhD
SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
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Th-2 Th-2
Th-1 Th-1
Atopic PatientAllergen IT treated
Atopic Patient
(Guerra. JACI 2001;107:647-53)
Prof Ariyanto Harsono MD PhD SpA(K)
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(Akdis, J Clin Invest 1998;102:98-106)
Prof Ariyanto Harsono MD PhD SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
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Allergen extract:-Whole body extract -Pure venom extract
10% residual risk
Prof Ariyanto Harsono MD PhD SpA(K)
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•Effective in Seasonal allergic rhinitis
•Less effective in perennial allergic rhinitis
•Mark improvement in tolerance of cat exposure
Prof Ariyanto Harsono MD PhD SpA(K)
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•Common indication in North America and Europe•Meta analysis 1954-1998: beneficial effect•DBPC: 60-75% reduce of symptom score in patients with grass pollen allergy•Economic analysis: less cost than pharmaco- therapy
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GROUP
ControlSub-cutan ITSub-lingual IT
Mea
n
18
16
14
12
10
8
6
PEFR Variability Pre
(%)
PEFR Variability Pos
t (%)
Study from Surabaya
(Harsono. Fol Med Indones 2003;39:223-7)
Prof Ariyanto Harsono MD PhD SpA(K)
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IL-12
IL-5IL-4
IL-13
Immunotherapy
IgE IgG
Asthma symptom(Rev FEV-1)
Asthma symptom(Rev FEV-1)
Cortikosteroid
IFN- IL-2
//
Group A
Group B
Group C
Study from Surabaya
(Harsono, Dissertation 2004)Prof Ariyanto Harsono MD PhD
SpA(K)
Prof Ariyanto Harsono MD PhD SpA(K)
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-5
0
5
10
15
Group A Group B Group C
IL_5
IL_2
Reduced of IL-5 correlate with significant increased of IL-2
Analysis of discriminant
Prof Ariyanto Harsono MD PhD SpA(K)
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The improvement of FEV-1 reversibility is a cumulative result of 4 factors
• decreased IL-4, enhances inhibition of IgE production.• decreased IL-5, enhances inhibition of eosinophil
maturation in the stem cell, chemo taxis, and prolonged life span.
• increased IFN- enhances isotype switching of immunoglobuline production in favor of IgG subclass instead of IgE.
• increased IL-2 enhances the affinity maturation and differentiation of B cells giving rise to the generation of B memory cells and antibody secreting plasma cells producing IgG.
Prof Ariyanto Harsono MD PhD SpA(K)
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Conclusion
Immunotherapy in asthmatic children results in elevation of IFN- and IL-2, diminish IL-4 and IL-5.
Addition of inhaled corticosteroid to immunotherapy results in marked attenuation of IL-5 correlates with greater elevation of IL-2 and play an important role in the modulation of immune response resulting in the improvement of FEV-1 reversibility.
Prof Ariyanto Harsono MD PhD SpA(K)
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•Reduce development of Rhinitis to asthma•Reduce developing new sensitization•Prevent allergic children from going on to develop asthma•Rhinitis symptom seem to show more sustain relief
Prof Ariyanto Harsono MD PhD SpA(K)
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UK 1957-1986: 26 fatal cases 17 for asthma5-35% systemic reactions for asthma
Contra indications:•Auto-immune disease•Malignancy•Cardiac disease•Patients receiving beta blocker
Prof Ariyanto Harsono MD PhD SpA(K)
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1. The primary mechanism of action is a shift in the balance of Th-1 and Th-2 cytokine expression in the allergen-challenged site.
2. Allergen IT is highly form of treatment of IgE mediated diseases.
3. Highly effective for allergic rhinitis and hypersensitivity to wasp and bee venom.
4. Consideration for primary use in asthma is still controversial in regards the potential development of adverse event.
Prof Ariyanto Harsono MD PhD SpA(K)
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![Allergic Rhinitis - sborl.es filesymptoms that continue year round (seasonal or perennial allergic rhinitis) may benefit most from immunotherapy [II D*]. Allergen immunotherapy can](https://img.dokumen.tips/doc/110x75/5dd1130ad6be591ccb641892/allergic-rhinitis-sborles-that-continue-year-round-seasonal-or-perennial-allergic.jpg)
